Study sheds light on public attitudes toward transplant allocations

Study sheds light on public attitudes toward transplant allocations

Becoming an organ donor has never been easier. Registration is available online when renewing a driver's license or, for iPhone users, renewed through an app.

Still, the people in urgent need of transplants far outnumber the available organs. Every eight minutes someone in the United States is added to the waiting list, and every day 17 people in the United States die while waiting for a transplant.

“Given the staggering need, we were interested in whether Americans deserve some recipients more than others based on the reason for needing a transplant and whether a recipient’s race or ethnicity plays a role.”Social Science Quarterly.

Haeder said research on the topic is scarce and limited in terms of organs and behaviors. This study is comprehensive and is the first to evaluate organ failure from workplace injuries (such as exposure to coal dust, which contributes to black lung disease) and mental health factors (e.g., alcohol use disorders).

For their study, Haeder and a colleague from Utah Valley University surveyed 4,177 American citizens in the USA from March 18 to April 18, 2022.

The individual in the first scenario had “a genetic disorder that destroyed his kidneys” and required a kidney transplant. The second had “worked in a coal mine all his life” and needed a lung transplant for black lung disease. The third was “very sick with Covid-19”, had not been vaccinated against Covid-19 and needed a lung transplant. And the fourth had an alcohol use disorder and needed a liver transplant.

To gain insight into the influence of race and ethnicity on transplant outcomes, researchers used identifiable names that were prescreened in another study: Ronny Nielsen (White), Deshawn Washington (Black), Luis Hernandez (Hispanic), and Yang Chen (Asian).

After considering all four scenarios, respondents used a five-point Likert scale ranging from “definitely yes” to “definitely not” to indicate whether the characters should be considered for a transplant. They also answered survey questions that assessed their political ideologies (liberal or conservative) and racial resentments.

A comparison of predicted means of assessing disparities found that the public considers the circumstances of potential organ recipients, but not their race or ethnicity.

“Respondents generally supported the person dealing with black lung disease, followed by the person dealing with kidney disease and the Covid-19 patient, and finally the person dealing with alcohol use disorder,” Haeder said.

The public generally establishes a clear ranking of potential transplant candidates based on the circumstances that led to their transplant needs. The most well-known results were substantial support for people dealing with black lung disease, which often outpaced all other people, and support for people with genetic kidney disease over both people dealing with Covid-19 and alcohol use disorder. “

Simon F. Haeder, PhD, health policy analyst at Texas A&M University School of Public Health

According to Haeder, liberals and respondents low in racial resentment generally showed no meaningful differences between the individual's approach to alcohol use disorder and the unvaccinated Covid-19 patient, while conservatives and those high in racial resentment did.

“It’s a finding that stands out with those dealing with alcohol use disorders,” Haeder said. “While this condition is accepted as an illness, those with this disorder in our study were consistently ranked as the least deserving, indicating ongoing stigma.”

The lack of results related to racial and ethnic differences were also notable, he said, noting that in cases where differences were identified, they appeared to slightly favor racial and ethnic minorities.

“The bigger question here is whether and how public attitudes should be incorporated into transplant allocations,” Haeder said. “On the one hand, better aligning allocation decisions with public opinion could lead to more people becoming donors, but on the other hand, the scarcity of organs means that rules governing their use are crucial.”

Haeder said the study's results could lead to more opportunities to increase the number of organs available for transplantation or develop innovative approaches to the organ shortage.

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